Reimbursement, Reimbursement Specialist (Claim Denial and Appeal Focus)(Remote)
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Castle Biosciences Inc. is growing, and we are looking to hire a Reimbursement Specialist (Claim Denial and Appeal Focus) working remotely from your home office based in the USA, with a start date prior to July 24, 2025.
A DAY IN THE LIFE OF Reimbursement Specialist (Claim Denial and Appeal Focus),
This individual is responsible for resolving denied insurance claims for laboratory services by providing payers with requested or additional documentation, initiating the appeal process on behalf of the patient, and delivering the highest level of customer service to both internal and external customers. The majority of time will be spent reviewing Explanation of Benefits (EOBs), electronic remittance advice, and denial letters, assigning appropriate ANSI codes, and taking necessary action within the billing system. This role will also involve placing calls to insurance companies to obtain missing information or determine the status of submitted claims as needed. Additionally, the individual will read and interpret medical record documents and payer medical policies to ensure that key "medical necessity" criteria are documented by the clinician. They will also create custom appeals with well-supported arguments to ensure denials are overturned based on payer medical policy or state laws.
REQUIRED QUALIFICATIONS
• Minimum Requirements
• Two years of health insurance billing with experience in identifying and resolving claim issues for laboratory tests.
• Must have a working knowledge of various payers' designations of authorized representative forms.
• Experience handling a high volume of claims work on a daily basis (35 plus claims per day)
• Typing speed of 35 or more words per minute, with 90% or greater accuracy.
• One year minimum experience in a medical/healthcare Reimbursement Specialist role with one company.
• Please see the attached job description for additional roles, responsibilities, and requirements.
TRAVEL REQUIREMENTS
• Apply Now
Learn more at www.CastleBiosciences.com
Castle Biosciences Inc. is growing, and we are looking to hire a Reimbursement Specialist (Claim Denial and Appeal Focus) working remotely from your home office based in the USA, with a start date prior to July 24, 2025.
A DAY IN THE LIFE OF Reimbursement Specialist (Claim Denial and Appeal Focus),
This individual is responsible for resolving denied insurance claims for laboratory services by providing payers with requested or additional documentation, initiating the appeal process on behalf of the patient, and delivering the highest level of customer service to both internal and external customers. The majority of time will be spent reviewing Explanation of Benefits (EOBs), electronic remittance advice, and denial letters, assigning appropriate ANSI codes, and taking necessary action within the billing system. This role will also involve placing calls to insurance companies to obtain missing information or determine the status of submitted claims as needed. Additionally, the individual will read and interpret medical record documents and payer medical policies to ensure that key "medical necessity" criteria are documented by the clinician. They will also create custom appeals with well-supported arguments to ensure denials are overturned based on payer medical policy or state laws.
REQUIRED QUALIFICATIONS
• Minimum Requirements
• Two years of health insurance billing with experience in identifying and resolving claim issues for laboratory tests.
• Must have a working knowledge of various payers' designations of authorized representative forms.
• Experience handling a high volume of claims work on a daily basis (35 plus claims per day)
• Typing speed of 35 or more words per minute, with 90% or greater accuracy.
• One year minimum experience in a medical/healthcare Reimbursement Specialist role with one company.
• Please see the attached job description for additional roles, responsibilities, and requirements.
TRAVEL REQUIREMENTS
• Apply Now